- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.79 / $68.67 / $165.73
| Facility | 26 | $51.79 | $68.67 | $165.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.72 / $128.06 / $230.92
| Professional | | $99.72 | $128.06 | $230.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.72 / $119.05 / $257.33
| Professional | | $114.72 | $119.05 | $257.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.14 / $61.14 / $61.14
| Facility | 26 | $61.14 | $61.14 | $61.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.25 / $220.87 / $595.95
| Professional | | $96.25 | $220.87 | $595.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.90 / $177.19 / $443.45
| Professional | | $136.90 | $177.19 | $443.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.69 / $133.69 / $133.69
| Professional | | $133.69 | $133.69 | $133.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.79 / $94.78 / $169.35
| Facility | 26 | $51.79 | $94.78 | $169.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.53 / $151.54 / $257.61
| Professional | | $104.53 | $151.54 | $257.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.60 / $676.50 / $727.40
| Professional | | $154.60 | $676.50 | $727.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.57 / $61.14 / $61.14
| Facility | 26 | $37.57 | $61.14 | $61.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.24 / $210.46 / $592.96
| Professional | | $102.24 | $210.46 | $592.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.73 / $52.73 / $91.00
| Facility | 26 | $52.73 | $52.73 | $91.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.44 / $115.64 / $520.85
| Professional | | $113.44 | $115.64 | $520.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.74 / $165.74 / $475.13
| Professional | | $114.74 | $165.74 | $475.13 |